Knee Pain
Quadriceps Tendinopathy
The quadriceps tendon attaches your quadriceps muscles to your kneecap (patella). It works to straighten your knee and helps you walk, jump, and climb stairs.
If the tendon becomes inflamed, it’s called quadriceps tendinitis (tendonitis) or tendinopathy.
Inflammation of the tendon, or tendinitis, is most common in athletes whose sports involve frequent jumping, but people who don’t play any sport can get quadriceps tendinitis.
Physiotherapy treatment is often very successful but if persistent there are a lot of other treatments available, such as prolotherapy.
The most common cause of quadriceps tendinitis is overuse. This occurs when the tendon repeatedly moves in a specific way, which leads to small tears.
Normally, your body tries to fix these tears. But if you continue repeating the same movement, more tears will develop.
Repeated actions can also cause quadriceps tendinitis, like:
sports
trauma, like jumping on a hard surface
sudden increase in physical activity
poor posture
poor walking habits
Any active person can get quadriceps tendinitis. But the risk is higher in athletes, especially if you:
run on hard surfaces
play jumping sports, like volleyball and basketball
exercise without warming up
exercise without enough recovery time
repeatedly squat or kneel
Other factors that increase your risk include:
Age. As you get older, the tendons become less flexible and more prone to inflammation.
Weight. Excess body weight puts extra stress on the tendons.
Tight muscles. Tight hamstrings and quad muscles increase pressure on your tendons.
Chronic disease. Some diseases, like lupus and diabetes, reduce blood supply to the knee. This weakens the tendons and increases the risk of tendinitis.
Alignment problems. If your joints or bones aren’t properly aligned, one leg will be placed under more stress. Muscular imbalances can have a similar effect.
Activity-Related Anterior Knee Pain: pain at the bottom of the thigh, just above the kneecap that gets worse with activity
Localised Tenderness: discomfort when you press on the top edge of the kneecap
Knee Swelling: around the tendon and kneecap
Knee Stiffness: particularly when you first get up in the morning or after sitting down for a while
Weakness: in and around the knee, decreased power during “push-off” phase of running/jumping
Symptoms of quadriceps tendinopathy can be classified into 5 stages:
Stage 0: No pain
Stage 1: Pain only after intense sports activities. No functional impairment
Stage 2: Moderate pain during sporting activities. No restriction on performance
Stage 3: Pain during sporting activities with slight restriction on performance
Stage 4: Pain with severe restriction of sports performance
Stage 5: Pain during daily activities. Unable to participate in sports activities
Generally, common symptoms of quadriceps tendon pain include:
Quad pain above kneecap that is worse during and after activity.
Often, there is no swelling, locking, or giving away of the knee.
It is often tender to touch the quadriceps tendon.
Your doctor will perform a clinical examination to rule out other causes of pain above kneecap or at the front of the knee, such as kneecap arthritis, fat pad impingement, torn meniscus, pes bursitis, housemaid’s knee, and patellar tendonitis.
Often, we use imaging to diagnose quad tendonitis and rule out other causes. Usually, ultrasound and MRI scans can see changes in swelling and collagen breakdown of the tendon. Generally, ultrasound has advantages over MRI scans, including seeing calcification more clearly and at a lower cost.
Most people suffering from quadriceps tendonitis pain respond well to non-surgical treatment which typically includes:
Rest: Avoiding activities that bring on your knee pain is vital. Modify your training so you are not exacerbating your symptoms e.g. reduce the frequency or duration of training sessions, or switch to things like cycling or swimming. In most cases, relative rest is best but in severe cases, complete rest may be necessary using a knee brace or splint
Ice: Regularly applying an ice pack to the knee throughout the day, especially before and after sports, for 10-15 minutes can help to reduce inflammation and quadriceps tendonitis pain
Physical Therapy: your physical therapist may use modalities such as ultrasound, acupuncture, electrical stimulation
Massage: Deep transverse friction massage can be extremely effective in chronic cases of quadriceps tendinopathy. It helps to break-down adhesions and realign the collagen fibres in the tendon so that tendon heals properly
Bracing/Taping: Your therapist may tape up your knee to avoid overloading the tendon and prevent pain during day to day activities. Many people find wearing a knee strap particularly helpful, especially when they returns to sports
Orthotics: Shoe orthotics help to address and biomechanical issues that may be contributing to your quadriceps tendonitis such as arch supports
Stretching Exercises: Knee stretches to improve the flexibility of the calves, hamstrings and quadriceps muscles to reduce the tension through the tendon
Strengthening Exercises: Strengthening exercises for the quadriceps muscles, particularly the VMO muscles which control kneecap movement, hamstrings and glutes muscles, helps reduce the strain on the tendon. Eccentric training for the quads is particularly effective – this is when you strengthen the muscle as it lengthens rather than contracts
Medication: your doctor may advise non-steroidal anti-inflammatory medication to help reduce quadriceps tendonitis pain and swelling in the knee
Injections: In more severe cases, your doctor may recommend either corticosteroid or plasma-rich protein (PRP) knee injections for quadriceps tendinopathy that is failing to resolve
If the symptoms of quadriceps tendinopathy fail to improve with at least 3 months of conservative treatment, or the tendon has completely ruptured, then your doctor may advise knee surgery.
Surgery for quadriceps tendinopathy involves removing the damaged portion of tendon, repairing it and restoring the blood supply to the tendon, known as revascularisation.
Quadriceps tendonitis surgery is usually done arthroscopically, i.e. key-hole surgery, but in some case more extensive open surgery may be required.
If there is a complete quads tendon rupture, then surgery is needed to restore the extensor mechanism.
Holes are made in the kneecap with a special drill and sutures are places in the tendon.
The sutures are carefully tied onto the kneecap, through the drill holes, to ensure the right level of tension.
A knee immobiliser brace is usually worn after surgery while the quadriceps tendon is healing.
Most cases of acute quadriceps tendonitis knee pain will settle within 6-12 weeks with non-surgical treatment. Chronic quadriceps tendinosis may take longer, typically 3-6 months. The sooner treatment begins once you notice symptoms, the quicker you are likely to recover.
You will probably need 6-8 weeks of physical therapy alongside your daily programme of strengthening and stretching exercises.
As your strength, flexibility and endurance improves, you will be able to progress on to more challenging exercises and increase your activity level.
As the symptoms of quadriceps tendonitis begin to settle, you can gradually start returning to sport specific training, but start with low frequency, low intensity and short duration. Start slow and gradually build up, being guided by your knee pain – if it starts to hurt, that’s a sign you’ve done too much so back off a bit.
It is really important to avoid activities that aggravate your quadriceps tendonitis knee pain, and to continue you treatment until you have regained full range of motion, flexibility and strength in and around the knee. Failure to do so is likely to result in the symptoms coming back again.
How using the HeatPulse
and Thermosleeve can help
The Thermosleeve and HeatPulse are great tools for hot and cold therapy to help you recover from your surgery.
Thermosleeve combines cold with compression for greater effectiveness in relieving pain and inflammation
HeatPulse combines heat and massage to boost blood flow to your knee, encouraging healing and improving range of motion
Swelling after knee surgery can last for three to six months after surgery. To help reduce inflammation and pain, you can use the Thermosleeve three to four times a day for about 10-20 minutes during the first few days after surgery.
After the initial swelling has gone down, you can alternate between the Thermosleeve and the HeatPulse to relax the muscles and ease stiffness.
The Thermosleeve and HeatPulse are great tools for hot and cold therapy to help you recover from your surgery.
Thermosleeve combines cold with compression for greater effectiveness in relieving pain and inflammation
HeatPulse combines heat and massage to boost blood flow to your knee, encouraging healing and improving range of motion
Swelling after knee surgery can last for three to six months after surgery. To help reduce inflammation and pain, you can use the Thermosleeve three to four times a day for about 10-20 minutes during the first few days after surgery.
After the initial swelling has gone down, you can alternate between the Thermosleeve and the HeatPulse to relax the muscles and ease stiffness.
Hear from customers
who have experienced relief
